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Obesity and Weight Management

Can`t control weight



I am 47 years old, had a hysterectomy two years ago, and have gained 20 lbs. since. I have tried many diets, (counting calories, low carb, etc) and have done some exercise. I can`t seem to even lose one pound. My knees and feet hurt when I`m on my feet for a few hours. I am 65 lbs overweight and may not be a candidate for any gastric bypass surgery. I`m at wits end and need help. What do you suggest?


I would recommend that you see your doctor to make sure that you have no medical problems that are contributing to being overweight or making it difficult to lose weight (i.e. certain medications and conditions such as thyroid problems). Also, reviewing your weight management history with your doctor will help identify whether you have had "successes" (any amount of weight loss) even if it is short-term and explore reasons for relapse. It will also help to identify any barriers or obstacles to successful weight management.

Next, it is important to remember that the key to losing weight is to develop a realistic goal for weight loss. Most people want to lose 20 lbs and want to do it over a short time span (i.e. 1-2 months). This is not a realistic goal because even if you are able to achieve it with the existing diets, the relapse weight gain is high. The recommended rate of weight loss is 1-2 lbs per week which has been associated with eating 500 calories less per day. This would be equivalent, for example, to anything on the MacDonald menu, or 2 cans of soda.

It is also recommended that you eat a balanced meal: small portions of meat with an increase in vegetables to 5-7 servings (green leafy, beans, etc.) and less on the starch (corn and breads). Additionally, making sure that you eat at least 4-5 very small meals throughout the day will help keep your metabolism high. Eating three large meals or skipping meals, especially breakfast, will slow the metabolism and make it more difficult to burn off the excess calories. It you can't burn off the calories, the body turns it into fat.

Another recommendation is to add water to your diet - at least 8 8oz. glasses per day. This is necessary because most of what we consider "hunger" is really thirst, because both of these signals lie close to each other in the brain. Therefore, when you are feeling hungry, if you drink water first it may relieve the hunger and will help you eat less.

Weight loss has to incorporate daily exercise of at least 30 minutes, which can consist of high intensity workouts or low intensity walking. After getting cleared by your doctor, it is recommended walking at least 30 minutes everyday.  This will help you maintain the weight loss that you experience by making changes in your diet. The key is that when you start an exercise program that you do not increase your calorie intake.

Finally, behavioral counseling has been shown to be helpful along with the above recommendations. This type of counseling will help explore some of the emotional and psychological aspects of being overweight and issues with weight management, such as abuse, self-esteem, and life events that make weight loss challenging.

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Response by:

Esa M Davis, MD, MPH Esa M Davis, MD, MPH
Adjunct Assistant Professor of Family Medicine
School of Medicine
Case Western Reserve University